Scoping study of definitions and instruments measuring vulnerability in older adults

BACKGROUND

It is important to foster social participation and health equity, especially for older adults in situations of vulnerability. Despite growing interest in vulnerability, there is no consensus regarding how to define or measure this concept. This paper provides an inventory and synthesis of definitions of and instruments measuring vulnerability in older adults.

METHODS

Using a scoping study framework, eight databases (Abstracts in Social Gerontology, Academic Search Complete, AgeLine, CINAHL, MEDLINE, SocINDEX, PsycInfo, Scopus) were searched with relevant keywords [Vulnerab* AND (Concept*, Defin*, Meaning, Terminology, Measurement, Assessment*, Indicator*, Instrument*, Scale*, Questionnaire* OR Test*) AND (Aging, Aging, Elder*, Gerontolog*, Older OR Senior*)].

RESULTS

Thirty-one original definitions and five measuring instruments were identified, content-analyzed, and compared. Vulnerability definitions mostly focused on people under conditions that increased their risk of harm because of individual physical factors, the environment, and their interaction. Considering these definitions, experts in the field of aging, including two representing older adults, participated in a workshop, and a consensus was reached to define a situation of vulnerability as "a set of circumstances in which one or more individuals experience, at a specific moment in time, one or multiple physiological, psychological, socioeconomic or social difficulties that may interact to increase their risk of being harmed or having coping challenges that have a negative impact on their life." Although none of the measures fully targeted this definition, the Perceived Vulnerability Scale (PVS) is one of the most complete measures, with 22 items considering feelings of vulnerability toward personal and environmental factors, and good psychometric properties.

CONCLUSIONS

The proposed definition and the PVS help to provide a common language and measure in health and social sciences research, policy and practice identifying and reaching older adults in situations of vulnerability and intervening to foster social participation and health equity.

Screening for Functional Cognition in Postacute Care and the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014

Occupational therapists have a long history of assessing functional cognition, defined as the ability to use and integrate thinking and performance skills to accomplish complex everyday activities. In response to passage of the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014 (Pub. L. 113-185), the American Occupational Therapy Association has been advocating that the Centers for Medicare and Medicaid Services consider functional cognition for inclusion in routine patient assessment in postacute care settings, with important implications for occupational therapy. These efforts have the potential to increase referrals to occupational therapy, emphasize the importance of addressing functional cognition in occupational therapy practice, and support the value of occupational therapy in achieving optimal postacute care outcomes.

Demographic and Socioeconomic Determinants of Self-Efficacy: An Empirical Study of Korean Older Adults

This study conceptualizes the dimensions of older adults' self-efficacy and identifies its determinants by using panel data collected by the National Pension Research Institute in Korea. The analysis supported the conceptualization of older people's self-efficacy as a multidimensional construct and found strong support for the three subscales. For older adults in Korea, general self-efficacy was condensed into a sense of competence. Older adults' social self-efficacy was delineated into two subscales: inward social self-efficacy and interactive social self-efficacy. Inward social self-efficacy could be characterized as a set of inward-looking social capabilities, whereas interactive self-efficacy could be considered as a set of relation-oriented capabilities with various groups of individuals. Of the three regression models representing dimensions of older people's self-efficacy, each model uncovered its own set of variables that played a decisive role in perceived self-efficacy. Demographic variables were more effective determinants of older adults' self-efficacy than socioeconomic factors.